Study Questions:

What is the full extent of cognitive function before transcatheter aortic valve replacement (TAVR), and the degree to which there is an association with preprocedural brain pathology, as measured by 3-T T2 fluid-attenuated inversion recovery (FLAIR) imaging?

Conclusions:

The authors concluded that there was a significant proportion of aortic stenosis patients with impaired cognition before TAVR, with a relationship between baseline cognitive function and lesion burden likely attributable to longstanding cerebrovascular disease.

Perspective:

This study reports that a significant proportion of older TAVR patients with high surgical risk have impaired cognitive domains before intervention. In addition, there was a significant relationship between baseline cognitive function and pre-TAVR MRI brain lesion burden, which is likely attributable to underlying cerebrovascular disease. It is understandable that there was no further loss over time after TAVR, given the level of pre-TAVR cognitive dysfunction present, producing a floor effect. Additional studies are indicated to assess whether lower-risk patients with presumably less burden of cerebrovascular disease will be at a higher risk for post-TAVR cognitive dysfunction.